When someone dies by suicide, it can have devastating effects on the people left behind. This is particularly true in close-knit communities such as the military, where one death by suicide may leave many survivors struggling to cope with the death. Some of the loss survivors may even be more likely to attempt suicide themselves. Unfortunately, very little has been known about how many people are affected by a suicide, how they are affected, or how they can best be helped because very little research has been done on bereavement after suicide.

Now, however, Julie Cerel of the University of Kentucky has begun to shed some light on this important issue. According to her research, Veterans who know someone who has died from suicide are more likely to be depressed, more likely to suffer from anxiety, and more likely to think about suicide than Veterans who do not know someone who has died by suicide. The details from the research should lead to improvements in how clinicians diagnose and treat Veterans who are themselves at risk of attempting suicide.

By randomly calling phone numbers, both landline and cell, Cerel recruited 931 Veterans living in Kentucky to take part in her survey. The Veterans were asked if anyone they knew had died by suicide, and if the answer was yes, they were asked a number of questions to determine such things as their relationship with the person who died, how close they felt to that person, and how long ago the suicide had occurred. They were also asked if they knew another service member who had died in combat, during a training accident, or any other way that was sudden and traumatic but not due to suicide. The Veterans were also asked for such basic information as age, race, sex, marital status, the branch of service in which they served, how long they served, and whether they had been deployed to combat zones. Finally they were asked questions designed to determine whether they had symptoms of depression or anxiety.

After analyzing their data, they found that Veterans who had known someone who had died by suicide were almost twice as likely as other Veterans to score high enough on a depression scale that they were probably clinically depressed and were more than twice as likely to have an anxiety diagnosis. The suicide-exposed Veterans were also much more likely to have reported that they had considered suicide themselves. Furthermore, Veterans who had known someone who had died by suicide and then later had been exposed to a sudden traumatic death were four times as likely to have thought about their own suicide as those Veterans who had been exposed to neither a suicide nor a traumatic death. It seems, Cerel says, that there is something about having known someone who died suicide that makes Veterans much more vulnerable to thinking about suicide themselves in the wake of the violent death of another service member they knew.

Overall, Cerel says, the results for Veterans are very similar to results from a previous general population study on the effects of knowing someone who had died by suicide. That study found that members of the general population were about as likely as Veterans to have known someone who had died by suicide and that they also carried emotional effects from the experience.

Because the Veterans in the study were, on average, relatively old—with an average age of 60 years, Cerel says that it will be important to repeat the study with younger Veterans or active-duty service members to see how the recent increases in suicide rates among members of the military might affect her conclusions.

Her findings have a number of implications for the diagnosis and treatment of Veterans at risk of suicide. For one thing, Cerel says, clinicians need to pay attention to learning whether their patients have known people who have died by suicide, not just genetically related family members, but people such as other service members to whom they felt a close relationship. In particular, it will be important to identify those patients who knew someone who died by suicide and later knew a fellow service member who died a traumatic death since those patients may be at a particularly high risk of attempting suicide themselves. Because it can be uncomfortable to ask such questions, clinicians may sometimes fail to learn these details about their patients, Cerel says, but her research indicates that it will be crucial for clinicians to get the training and encouragement they need to explore these issues.